超声内镜结合CT扫描在食管癌临床分期中的应用  

Comparison between Applications of Endoscopic Ultrasonography and Computed Tomography in Clinical Staging of Esophageal Cancer

作　　者：李娟[1] 祝淑钗[1] 刘志坤[1] 王玉祥[1] 沈文斌[1] 

机构地区：[1]河北医科大学第四医院放疗三科,石家庄市050011

出　　处：《中国肿瘤临床》2011年第1期46-49,共4页Chinese Journal of Clinical Oncology

基　　金：河北省普通高等学校肿瘤学强势特色学科建设项目(编号:冀教高[2005]52号);河北省医学适用技术跟踪项目(编号:GL200848);河北省卫生厅科研基金项目资助(编号:20090149;08162)~~

摘　　要：目的:比较超声内镜(EUS)、CT扫描及两者联合应用在判定胸段食管癌术前T、N分期中的应用价值。方法:48例可切除胸段食管癌患者术前均行EUS检查和CT扫描,同时分别进行T、N分期,并与术后病理分期进行对照分析。结果:食管癌术前EUS检查T、N分期的诊断准确率分别为77.1%(37/48)、75.0%(36/48),T_1、T_2、T_3、T_4期诊断准确率分别为87.5%、57.1%、94.1%和100%;食管癌术前CT检查T、N分期的诊断准确率分别为52.1%(25/48)和77.1%(37/48),T_1、T_2、T_3、T_4期诊断准确率分别为37.5%、33.3%、81.2%和100%;EUS联合CT检查T、N分期的诊断准确率分别为79.2%(38/48)和77.1%(37/48)。应用EUS测得淋巴结短径构建ROC曲线,曲线下面积为0.775,以淋巴结短径≥7.5mm作为阳性淋巴结的诊断界点,可能提高判断淋巴结转移的准确性。结论:EUS检查在食管癌术前分期的价值优于CT扫描,尤其对T分期诊断的准确率比较高。Objective： TO compare the value of endoscopic ultrasonography （ EUS ）, computed tomography （ CT ） and the combined application of both technologies in deciding preoperative T and N staging of thoracic esophageal cancer. Methods： Both EUS and CT were conducted preoperatively in 48 patients with resectable thoracic esophageal cancer, with T and N staging and cross-check analysis of the clinicopathologic staging before and after surgery. Results： The T and N staging accuracy rates of EUS examination were 77.1% （ 37/48 ） and 75.0% （ 36/48 ）, respectively （ T1 87.5%, T2 57.1%, T3 94.1%, T, 100% ）. CT examination had T and N staging accuracy rates of 52.1% （ 25/48 ） and 77.1% （ 37/48 ）, respectively （ TI 37.5%, T2 33.3%, T3 81.2%, T4 100% ）. Combined examination of EUS and CT showed T and N staging accuracy rates of 79.2% （ 38/48 ） and 77.1% （ 37/48 ）, respectively. The Kappa values of EUS detection in preoperative T and N stage were 0.659 （ P = 0.000 ） and 0.486 （ P = 0.001 ）, and the values of CT scanning were 0.364 （ P = 0.003 ） and 0.532 （ P = 0.000 ）. The results of EUS and CT combined examination for the dual staging were 0.693 （ P = 0.000 ） and 0.532 （ P = 0.000 ）. The consistency for CT scanning in N staging and the combined detection of CT and EUS in the T and N staging before surgery were both good （ 0.4 〈 Kappa value 〈 0.7 ）, but that for CT detection in preoperative T staging was poor （ Kappa value 〈 0.4 ）. EUS showed that the area under the ROC curve was 0.775 which was constructed by lymph node minor axis. Examining positive lymph nodes and using a cut-off value of ≥ 7.5ram for the shortest diameter would increase the detection accuracy of nodal metastasis. Conclusion： The diagnostic value of EUS is superior to CT scanning in preoperative T staging of esophageal cancer. The accuracy rate of both technologies in the preoperative diagnosis of N staging is high. The combined application of EUS and CT is expected to raise

关 键 词：超声内镜 食管癌 临床分期 CT断层扫描 

分 类 号：R735.1[医药卫生—肿瘤]